LESSON PLAN

ON

PLACENTA
 STUDENT PROFILE

Name of the Topic : Placenta

Name of the Subject : nursing education

Date : 14-11-2019

Time : 15 mins

Venue : GFTAM

Group : 4th Year B.Sc., Nursing students

Method of Teaching : Lecture cum Discussion

AV AIDS : Black board, Chart, Flip Chart, Flash cards,PPT,Handout

Name of the Student : 18N305157005
General Objective :

By the end of the lesson plan on “placenta” the student will be able to gain indepth knowledge regarding
placenta and to develop teaching & communication skills.

Specific Objectives :
At the end of presentation, the students will be able :
 To Introduction about placenta
 To Explain the development of placenta
 To Explain about the mature placenta
 To Describe the functions of placenta
 To Describe the anatomical variations of the placenta and cord.
 SPECIFIC TIME CONTENT TEACHING AV AIDS EVALUATION
OBJECTIVES LEARNING
ACTIVITY
To list out 1min Lecture flash What are the
the cum cards types of
palcenta discussion placenta?
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
To introduce the 2min GENERAL INTRODUCTION : Black Lecture
placenta Only eutherian Mammals possess placenta. The human board cum
placenta is discoid, because if its shape; haemochorial, because discussion
of direct contact of the chorion with the maternal blood and
deciduas, because some maternal tissue is shed at parturition.
The placenta is attached to the uterine wall and establishes
connection between the mother and fetus through the
umbilical cord. The fact that maternal and fetal tissues come in
direct contact without rejection suggest immunological
acceptance of the fetal graft by the mother.
Early Development :
Within a few days of fertilization, the zygote developes into What are the
To explain the a blastocyst, a spherical structure composed of two distinct cell Lecture steps
development of 3 Min types, the inner cell mass, which will develop into the fetus and PPT cum including in
placenta an outer ring of trophoblast cells, which will develop into the discussion development
placenta and membranes. By 8 days, the trophoblasts begin to of placenta?
make human chorionic gonadotrophin (Hcce).
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
Implantation :
Once the blastocyst makes contact with the endometrian,
the trophoblast layer adheres to the endometrial, surface and
the process of placentation beings. By 10 days the blastocyst is
completely buried in the endometrie, which is now called the
deciduas.

Chorionic Villi :
Initially the blastocyst appears to be covered by fine downy
hair, which consists of the projections form the trophoblastic
layer. These proliferate and branch from about 3 weeks after
fertilization, forming the chorionic villi. The portion of deciduas
surrounding the blastocyst, where it projects into the uterine
cavity, is known as the deciduas capsularis. The villi erode the
walls of maternal blood vessels as they penetrate the deciduas,
opening them upto from a lake of maternal blood in which they
float. The opened blood vessels are known as sinuses, and the
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
areas surrounding the villi as blood spaces. The maternal blood
circulates slowly, enabling the villi to absorb food nad oxygen
and excrete waste. These are known as the nutritine villi. A
few villi more deeply attached to the deciduas and are called
anchoring villi.

Each chorionic villus is a branching structure arising from one

stem. Its centre consists of meroderm and fetal blood vessels,
and branches of the umbilical artery and vein, these are
covered by a single layer of cytotrophoblast cells and the
external layer of the villus.

Explain about 5min The mature placenta : Flash Lecture What is

the mature The placenta is completely formed and functioning 10 weeks Cards cum mature
placenta after fertilization. Between 12 and 20 weeks gestation, the discussion placenta?
placenta weighs more than the fetus because the fetal organs
are in sufficiently developed to cope with the metabolic process
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
of nutrition. Later in pregnancy some of the fetal organs, such
as the liver, begin to function, so the cytotrophoblast and the
syncytiotrophoblast gradually degenerate and this allows easier
exchange of oxygen and carbondioxide.
Describe the 5min Functions of Placenta: Hand Out Lecture What are the
functions of The placenta performs a variety of function for the cum functions of
placenta developing fetus. discussion placenta?
Respiration :During intrauterine life, no pulmonary exchange of methods
gases can take place so the fetus must obtain oxygen and
excrete carbon dioxide through the placenta. Oxygen from the
mothers haemoglobin passes into the fetal blood by simple
diffusion, similarly, the fetus gives off carbon dioxide into the
maternal blood.

Nutrition :The fetus needs nutrients for growth and

development. For instance, amino acids are required for body
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
Building, large quantities of glucose for energy and growth,
calcium and phosphorus for bones and teeth, and iron and
other minerals for blood formation. These nutrients are actively
transferred from the maternal to the fetal blood through the
walls of the villi.
Water, vitamins and minerals also pass to the fetus. Fats and
fat – soluble vitamins (A, D&E) cross the placenta only with
difficulty and mainly in the later stages of pregnancy.
Storage :The placenta metabolies glucose, stores it in the form
of glycogen and reconverts it to glucose as required. It can also
stone iron and the fat soluble vitamins.

Excretion :The main substance excreted from the fetus is

carbon dioxide. Bilirubin will also be excreted as red blood cells
are replaced relatively frequently. Ther is very little tissue
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
breakdown apart from this and the amounts of urea and uric
acid excreted are very small.
Protection :The placenta provides a limited barrier to infection
few bacteria can penetrate with the exception of the
treponema of syphilis and the tubercle bacillus. However
substances including alcohol, some chemicals associated with
smoking cigarettes and several types of viruses, such as human
cytomegalo virus and rubella are not fattened out.

Although some drugs will cross the placental barrier to the

fetus, many will be harmless and others, such as antibiotics
administered to a pregnant woman with syphilis are positively
beneficial.

Endocrine :Human chorionic gonadotrophin (HCU) is produced

by the cytotrophoblast layer of the chorionic villi. Initially it is
present in very large quantities.
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
Oestrogens are growth stimulating hormones, which are
secreted in large amounts throughout pregnancy. They are
produced by the placenta as the activity of the corpus lukem
declines.
Progesterone is made in the syncytial layer of the placenta in
increasing quantities until immediately before the onset of
labour when its level falls. It may be measured in the urine as
pregnavediol.
Human placental lactogen (HPL) has a role in glucose
metabolism in pregnancy. It appears to have a connection with
the activity of human growth hormone, although it does not
itself promote growth.
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity

To explaine 2 min The Placenta term : Flipchart Lecture What is term

about term At term the placenta is round flat mass about 20cm in Cum placenta
placenta diameter and 2-5cm thich at its centre. It weights Discussion
approximately one sixth of the babys weight, although this
proportion may be affected by the time at which the cord is
clamped owing to the varying amounts of fetal blood retained
in the vessels.
The maternal surface of the placenta is dark red in colour due
to maternal blood and because part of the basal deciduas will
have been separated with it. The surface is arranged in about
20 cotyledons (lobes), which are separated by sulci (furrous),
into which the deciduas dips down to form septa (walls). The
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
cotyledons are made up of lobules, each of which contains a
single villus with its branches. Sometimes deposites of lime
salts may be present o the surface, making it slightly gritty. This
has no clinical significance.
The fetal surface of the placenta has a shiny appearance
due to the amnion covering it. Branches of the umbilical vein
and arteries are visible, spreading out from the insertion of the
umbilical cord, which is normally in the centre. The amnion can
be placed off the surface of he chorion as far back as the
umbilical cord, where as eh chorion, being derived from the
same trophoblastic layer as the placenta, is continuous with the
chorionic plate and can not be separated from it

To Explain the 5min Anatomical variations of the placenta and cord : Picture Lecture What are the
anatomical A succenturiate lobe of placenta is the most significant of the cum anatomical
variations of
variations of variations inconfirmation of the placenta. A small extra lobe is discussion placenta and
placenta card?
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
present , separate from the main placenta, and joined it by
blood vessels that run through the membranes to reach it. The
danger is that this small lobe may be retained in utero after the
placenta is delivered, and if it is not removed, it may lead to
infection and haemorrhage. Every placenta must be examined
for evidence of a retained succenturiat lobe, which can be
identified by a hole in the membranes with vessels running to
it.
In circumvallate placenta an opaque ring in seen on the fetal
surface of the placenta. It is formed by a doubling back of the
chorion and amnion and may result in the membranes leaving
the placenta reaner the centre instead of at the edge as usual.
This placental variation is associated with prematurity, prenatal
bleeding, abruption, multiparity and early fluid loss.

In bipartite placenta, two complete and separate parts are

present, each with a cord leaving from it. The bipartite cord
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
Joins a short distance from the two parts of the placenta. This
is different from the two placentas in a twin pregnancy, where
there are also two separate umbilical cords. A tripartite
placenta is similar to a bipartite placenta but is has three
distinct parts.

In battle done insertion of the cord, the cord is attached at

the very edge of the placenta in the manner of a table tennis
bat. It is unimportant unless the attachment is fragile.
A velamentous insertion of the cord, occurs when the
cord is inserted into the membranes some distance from the
edge of the placenta. The umbilical vessels runs through the
membranes from the cord to the placenta. If the placenta is
normally situated, no harm will result to the fetus, but the cord
is likely to become detached upon applying traction during
active management of the third stage of labour. However if the
 Teaching
Specific
Time Content AV AIDs Learning Evaluation
Objectives
Activity
Placenta is low lying. The vessels may pass across the uterine
as (vasa praevia). In this case there is great danger to the fetus
when the membranes rupture ad even more so during artificial
rupture, as the vessels may be torn, leading to rapid
exsanguinations of the fetus. If the onset of haemorrhage
should be assumed and the birth expedited. It is possible to
distinguish fetal blood form maternal blood by singers
alkalidenaturation test, although, in practice, time is so short
that it may not be possible to save the life of the baby. If the
baby survives, haemoglobin levels should be estimated after
birth.

Apart from the dangers noted above, these varieties of

confirmation have no clinical significance.
Shashi Munjala Mongia, ‘Sanjeev Kumar Jain.***Mukesh Yadav June 2011.

Placenta is the only organ to develop in adulthood and is the only one with a defined end day. The structure
of placenta has a strong relation with pregnancy length, physical milieu of mother and resemblance to the concept of
imhotep’(regarded as the first medicolegal expert) showing relation between forensic medicine histology, morphology and
pathology. Anemia in pregnancy is found to be associated with variable histomorphological changes in placenta, which
show a clear reflexion for the poor fetal out come. There is a threshold for the level of hemoglobin and consequently for
oxygen transport below which placental function is impaired. This explains the increased frequency of premature births,
fetal death and perinatal mortality and morbidity in anemia during pregnancy. The histomorpological findings of placenta
in anemic mothers which are an adaptation to maternal hypoxia can corelate with the poor fetal outcome giving a
documentary evidence and explanation against false Implications of neonatal deaths. This makes placenta as the much
required tool of present medicolegal scenario.
SUMMARY:

The fact that maternal and fetal tissues come in direct contact without rejection suggest immunological
acceptance of the fetal graft by the mother.Within a few days of fertilization, the zygote developes into a blastocyst, a
spherical structure composed of two distinct cell types, the inner cell mass, which will develop into the fetus and an outer
ring of trophoblast cells. The placenta performs a variety of function for the developing fetus. That is respiration,
nutrition, storage, excretion, protection, and endocrine.At term the placenta is round flat mass about 20cm in diameter
and 2-5cm thich at its centre. It weights approximately one sixth of the babys weigh.A succenturiate lobe of placenta is
the most significant of the variations inconfirmation of the placenta. A small extra lobe is,present , separate from the
main placenta, and joined it by blood vessels that run through the membranes to reach it.

BIBLIOGRAPHY:

1. Diane M. Fraser, Maruapet A. Cooper Myle Text Book for Midwives, Churchill Livingstone Elesevier Fifth edition
Page No. : 147 to 155.

2. D.C. Dutta’s A Text Book of Obstetrics HiralalKonar, Published by New Central Book Agency, Page No. : 28 to 40.
 DR. N.T.R UNIVERSITY OF
HEALTH SCIENCES,
VIJAYAWADA.

Signature of the internal examiner Signature of the External examiner